HIP IMPAIRMENT OF

Summary

The Veteran, an Army Veteran who served from February 1991 to June 1991, appeals the denial of service connection for bilateral hip arthritis, left knee arthritis and strain, and migraines. The Veteran claimed these conditions were secondary to his service-connected right knee and lumbar spine disabilities. The Board found that the Veteran had current diagnoses for all claimed conditions, including bilateral hip arthritis, left knee arthritis and strain, and migraines. Crucially, the Board found sufficient evidence to establish a secondary service connection for these conditions. For the hip and knee claims, the Board relied on VA examination findings and treatment notes indicating that the Veteran's gait mechanics were altered due to his service-connected right knee and lumbar spine conditions, leading to the development of hip and knee arthritis. For the migraines, the Board noted that the Veteran's headaches began after the onset of his lumbar spine disability and were exacerbated by medications prescribed for back pain. While one VA examiner opined against a connection for the headaches, another examiner found a nexus supported by medical literature. The Board found the evidence in relative equipoise and resolved the doubt in the Veteran's favor, granting service connection for all claimed conditions. The Board also noted that any evidence submitted after the hearing or more than 90 days following the hearing was not considered and advised the Veteran to file a Supplemental Claim for such evidence.

Rationale

Diagnosis of bilateral hip arthritis with pain; Altered gait mechanics due to service-connected right knee and lumbar spine disabilities; Medical opinion linking gait changes to bilateral hip arthritis

Full Decision Text

Citation Nr: A26004978
Decision Date: 01/20/26	Archive Date: 01/20/26

DOCKET NO. 200113-61304
DATE: January 20, 2026

ORDER

Entitlement to service connection for right hip arthritis is granted.

Entitlement to service connection for left hip arthritis is granted.

Entitlement to service connection for left knee arthritis and strain is granted.

Entitlement to service connection for migraines and migraine variants is granted.

FINDINGS OF FACT

1. The currently diagnosed left and right hip arthritis is caused by gait impairment from the service-connected right knee and lumbar spine disabilities.

2. The currently diagnosed left knee arthritis and strain are caused by gait impairment from the service-connected right knee and lumbar spine disabilities.

3. The currently diagnosed migraine and migraine variants are at least as likely as not caused by the service-connected lumbar spine disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for right hip arthritis as secondary to service-connected right knee and lumbar spine disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for left hip arthritis as secondary to service-connected right knee and lumbar spine disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for left knee arthritis and strain as secondary to service-connected right knee and lumbar spine disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for migraine and migraine variants as secondary to service-connected lumbar spine disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from February 1991 to June 1991.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2019 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). 

In August 2019, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the issues on appeal that were most recently addressed in a July 2019 rating decision. In August 2019, the AOJ issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of that decision. 

In the January 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on May 10, 2024. Therefore, the Board may only consider the evidence of record at the time of the August 2019 decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the related claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3)
.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the related claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 

Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability results from the service-connected disability. 38 U.S.C. §§ 1110, 1131; Spicer v. McDonough, 61 F.4th 1360, 1364, 1366 n.1 (Fed. Cir. 2023) (holding that section 1110 "requires compensation when a service-connected disease or injury is a but-for cause of a present-day disability" and noting that, apart from distinguishing whether service was during a period of war, 38 U.S.C. §§ 1110 and 1131 are identical).

1. Entitlement to service connection for right hip arthritis is granted.

2. Entitlement to service connection for left hip arthritis is granted.

The Veteran asserts that he has a bilateral hip disability that is caused by his service-connected right knee disability.

First, a bilateral hip disability has been present during the period on appeal. An August 2017 VA treatment note reports the Veteran was experiencing pain in the bilateral hips. In May 2024, the Veteran's primary care physician documented that the Veteran had bilateral hip arthritis. Thus, there is a diagnosis of bilateral hip arthritis and symptoms of hip pain during the period on appeal.

The evidence also shows that the bilateral hip arthritis is due to the Veteran's service-connected right knee disability. A September 2010 VA examiner documented that the Veteran had an antalgic gait due to right knee pain that altered his gait mechanics, and that he favored his left knee. A September 2018 VA treatment note reports the Veteran used a cane. In May 2024, the Veteran's primary care physician wrote that the Veteran's bilateral hip arthritis was caused by the service-connected right knee and lumbar spine disabilities that impaired the use of his lower extremities and caused gait changes. 

That evidence shows it is at least as likely as not that the diagnosed bilateral hip arthritis is due to impaired gait function due to service-connected right knee and lumbar spine disabilities. The criteria for secondary service connection for bilateral hip arthritis are met, and the claims are granted. 

3. Entitlement to service connection for left knee arthritis and strain is granted.

The Veteran asserts that the diagnosed left knee arthritis and strain are due to his service-connected right knee and lumbar spine disabilities. 

First, the Veteran was diagnosed with left knee disabilities during the period on appeal. VA has already favorably found that the Veteran is diagnosed with left knee strain, and in May 2024 the Veteran's primary care provider wrote that the Veteran had bilateral knee arthritis.

The evidence also shows the left knee disabilities are caused by the altered gait mechanics resulting from the service-connected right knee and lumbar spine disabilities. As noted, the medical records document the Veteran had altered gait mechanics and he used a cane due to service-connected right knee and lumbar spine disabilities. In December 2018, a VA examiner opined that the left knee strain was a direct result of the service-connected right knee disability because that conclusion was supported by the medical literature.

In June 2019, another VA examiner opined that the left knee disability was not due to the right knee disability because, in part, the Veteran did not have a significant leg length discrepancy or limp. That opinion failed to address the evidence of altered gait mechanics due to service-connected disability, to include favoring of the left knee. 

In May 2024, the Veteran's
 spine disabilities. As noted, the medical records document the Veteran had altered gait mechanics and he used a cane due to service-connected right knee and lumbar spine disabilities. In December 2018, a VA examiner opined that the left knee strain was a direct result of the service-connected right knee disability because that conclusion was supported by the medical literature.

In June 2019, another VA examiner opined that the left knee disability was not due to the right knee disability because, in part, the Veteran did not have a significant leg length discrepancy or limp. That opinion failed to address the evidence of altered gait mechanics due to service-connected disability, to include favoring of the left knee. 

In May 2024, the Veteran's primary care physician wrote that the Veteran had bilateral knee arthritis, that his service-connected right knee and back disabilities altered his gait, and that the left knee arthritis was caused by those gait changes. 

The evidence shows that it is at least as likely as not that the diagnosed left knee strain and arthritis are caused by the service-connected right knee and lower back disabilities. The criteria for secondary service connection are met, and the claim is granted.

4. Entitlement to service connection for migraine and migraine variants is granted.

The Veteran asserts that his diagnosed migraine, including migraine variants, is secondary to his lumbar spine disability. VA has already favorably found the Veteran has a current diagnosis of migraines, including migraine variants. 

In December 2017, a VA neurologist noted the Veteran's headaches were suspected due to medication overuse, and that the Veteran followed a private pain specialist for treatment of his back pain. In particular, the Veteran was advised to reduce his use of Percocet. The Veteran submitted the medical records from the private pain clinic showing that he was prescribed Percocet for back pain. At a September 2018 VA appointment, the Veteran reported that his back pain exacerbated his headaches. 

In December 2018, a VA examiner opined that the Veteran's headaches were due to his service-connected lumbar spine disability. In support of that opinion, the examiner stated the headaches began after the back disability and were a direct result of the back disability, and that the medical literature supported a nexus.

In June 2019, a different VA examiner opined that the headache condition was not due to the Veteran's service-connected disability because the two conditions were not medically related and the medical literature did not support a connection.

The VA opinions for and against the claim are in relative equipoise, and the VA treatment records tend to indicate the headache condition is caused or aggravated by the back disability, to include by medications prescribed to treat that back disability. After any reasonable doubt is resolved in the Veteran's favor, the criteria for secondary service connection for migraine and migraine variants are met, and the claim is granted. 

 

 

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Smith, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.